Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx

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Journal of King Saud University – Engineering Sciences

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Review

A fundamental review on composite materials and some of their

applications in biomedical engineering
Munonyedi Kelvin Egbo
Department of Mechanical Engineering, Wichita State University, Wichita 67260, KS, United States

a r t i c l e i n f o a b s t r a c t

Article history: Composites or composite materials are engineered materials that consist of two or more constituent
Received 12 February 2020 materials with wide discrepancies in their physical, chemical, and mechanical properties. The character-
Accepted 15 July 2020 istic properties of these composite are as a result of the individual properties of their constituent parts
Available online xxxx
and their respective volume fractions and arrangements in the material system. Depending on the
intended application, composites can be designed to satisfy specific geometrical, structural, mechanical,
Keywords: chemical, and sometimes aesthetic requirements. Areas of application of these synthetic materials
Composites
includes construction such as in buildings and bridges, automotive industry such as in car bodies, aero-
Biomedical engineering
Material science
nautic, naval (e.g., ships and boats), and in the biomedical fields. Although metallic, polymeric and cera-
Engineering materials mic biomaterials have been in use for medical treatments such as tissue repairs and replacements for
decades, composites are just coming to light. Therefore, the main purpose of this paper is to introduce
composite materials and discuss their current and potential use in the biomedical field.
Ó 2020 The Author. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an
open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Contents

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2. Classifications and properties of composites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2.1. Classifications of composite materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2.1.1. Particle-reinforced composites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2.1.2. Fiber-reinforced composites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2.1.3. Structural composites. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
2.2. Properties of composite materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3. Composite biomaterials and their applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.1. Cardiovascular applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.2. Dental applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.3. Artificial cartilage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.4. Artificial ligament . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.5. Joint prostheses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
3.6. Bone repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
4. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Declaration of Competing Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

Peer review under responsibility of King Saud University. 1. Introduction

The fabrication and the use of composite materials by the

human race dates back to over 6000 years ago when the first
Production and hosting by Elsevier recorded composite, wattle and daub, were used as building mate-
E-mail addresses: mkegbo@shockers.wichita.edu, egbomuna@gmail.com rials for wall construction Shaffer (1993). In recent century, this

https://doi.org/10.1016/j.jksues.2020.07.007
1018-3639/Ó 2020 The Author. Production and hosting by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
2 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx

construction material has since been replaced by another compos- with biomaterial designs that when manufactured and integrated
ite, concrete, which is composed of cement and reinforcements into the human body, either to facilitate tissue repair/healing or
such as gravel (aggregates) commonly known as loose stones, as a complete tissue replacement, would provide the intended
and the production capacity per annum has been reported to be functions without harming their immediate surrounding tissues
in millions of tons worldwide. Some of the mechanical properties or the whole body system Williams (2008). Biomaterials are tai-
of concrete are high compression strength and low tensile strength lored to suit their intended applications, which is the reason
Bazant and Murphy (1995); Shaffer (1993). Steel reinforcements behind their classifications. Composite biomaterials which is one
are usually incorporated during concrete casting to enhance its of such classifications is among the most widely used, both
tensile strength and consequently prevents it from failure under in vitro and in vivo, because of their high figure of merit. These
tensile loading Park and Paulay (1975). Another widely known multiphase materials can be easily manufactured to have unusual
composite is the Fiber-Reinforced Composite (FRP). combination of properties and shapes Durowaye et al. (2019);
The two common types of FRP are the Carbon Fiber-Reinforced Edoziuno et al. (2020). Specific material properties can be manu-
Composite (CFRC) and Glass Reinforced Plastic (GRP). Just as the factured with high accuracy with the simplest of manipulations
names imply, the fiber materials (or inclusion) used in the fabrica- of such parameters as the constituents’ volume ratios, fiber particle
tion of the CFRC and GRP are carbon and glass, respectively, and size, geometry, orientation and distribution, matrix type, and so on.
epoxy resin which is a thermoplastic, is often a general choice of As a result, composite materials have design flexibility and can
matrix, also known as a binder. Other types of composites include easily be tailored to have almost any desired property combina-
composite wood which are primarily thin layers or ‘‘plies” of woo- tions, unlike the metallic, polymeric, and ceramic biomaterials.
den boards glued together, Ceramic Matrix Composite (CMC), The aim of this paper is to introduce the composite biomaterials,
metal matrix composite (MMC), Polymer Matrix Composite discuss their functions as repair and replacement parts, and the
(PMC) and the materials known as advanced composites (ACM). recent trends in their applications. The advantages over other bio-
The inclusions used in CMC, MMC, and PMC are ceramic, metallic materials such as metallic, polymeric, and ceramics are also
and polymeric materials, respectively, and these composites are reviewed.
collectively known as conventional composites. The ACMs have
higher strengths, stiffness and modulus of elasticity and lower den-
2. Classifications and properties of composites
sities than the conventional composites due to the use high
strength low density fibers in their fabrication. These materials
Surprisingly, the future of technological advancement, in gen-
are also characterized by their ease of manufacture, chemical, tem-
eral, are dependent on composite materials Chawla (2012). These
perature and creep resistance. Fig. 1 shows the classification of
materials have unique advantages over other material types (met-
materials using the Venn diagram.
als, alloys, ceramics, and polymers) such as the ability to be man-
In general, composite materials find applications in different
ufactured to have predetermined physical, chemical, mechanical
areas of the human society such as in construction industry (e.g.,
and thermal properties and characteristics. For instance, the aero-
buildings and bridges), automotive industry (e.g., automobile parts
space industry is constantly looking for lightweight materials with
such as car bodies), aeronautics where materials with a property
properties that can only be found in heavy materials such as high
combination of high strength and low density is required, manu-
mechanical strength and stiffness, abrasion and wear resistant
facture of housing and industrial parts such as storage tanks, bath-
and so on. These aerodynamic materials are also expected to be
tubs, washing sinks, and shower stalls, and in medical field as
inert of corrosion attack, withstand high temperatures and easy
biomaterials for tissue repairs and replacements Al-Salloum and
to manufacture. Composite materials have been used, is still in
Almusallam (2003); Khan et al. (2017); Punyamurthy et al. (2017).
use, and will continue to be used to satisfy the material demand
Biomaterials engineering which is a multidisciplinary field that
of such industries, at least until a more sustainable alternative is
seeks to use engineered materials (biomaterials) for medical ther-
invented or discovered. Fig. 2(a) shows the comparison between
apeutic and/or diagnostic purposes Enderle and Bronzino (2012).
single phase monolithic materials with composite materials, while
This materials science and engineering entity work hand-in-hand
Fig. 2(b) shows the comparison between ceramics, polymers and
with biomedical engineering which is another multidisciplinary
composites.
field that applies concepts of engineering principles and design
The final properties of a manufactured composite material are
standards to medical biology for the purpose of advancing human
dependent on the individual properties of the constituents and
health Enderle and Bronzino (2012). Both areas rely on the knowl-
their relative amounts, geometry and distribution. The relative
edge of the human anatomy and physiology in order to come up
amounts of the constituent phases or materials can be expressed
as mass fractions or volume fractions, however, the latter is pre-
dominantly used by material engineers. Most composite materials
are composed to just two constituents; a matrix, which is usually a
material with relatively high ductility and low fracture strength
that surrounds the other constituent, often known as the inclusion
or the dispersed phase. The final properties of the composite mate-
rials strongly depends on the geometry and distribution of the lat-
ter phase. The geometry of the dispersed phase refers their shapes
and sizes while the distribution encompasses their positions and
orientations in the matrix. The schematic representations of these
geometrical and spatial characteristics of the particles of the inclu-
sion in a matrix can be found in Fig. 3.

2.1. Classifications of composite materials

Over the years, different authors have come up with different

Fig. 1. Classification of materials using the Venn diagram. classifications of composite materials. These classifications can be

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx 3

Fig. 2. Comparison between (a) pure metals and composite materials Chawla (2012) (b) ceramics, polymers and composites.

Fig. 3. Schematic descriptions of the various geometrical and spatial configurations of the particles of the inclusion of composites: (a) concentration (b) size (c) shape (d)
distribution (e) orientation (Callister, 2007).

collectively lumped into three categories (see Fig. 4): particle- 2007). Therefore, the major difference between the first two
reinforced composites which make use of inclusions that have uni- groups is the dispersed phase particle geometry. The particles in
form axes, fiber-reinforced composites which utilizes fiber-like the particle-type are usually spherical in shape while those of
inclusions, and structural composites which is a combination of the fiber-type have irregular geometries, but with higher length-
composites and homogenous materials (Callister and Rethwisch, to-diameter ratios, just as natural fibers.

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
4 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx

Fig. 4. Universal classification scheme for composites.

Both the particle- and fiber-reinforced composites can be

grouped according to the type of matrix used. The three major
groups are metal matrix composites, polymer matrix composites
and ceramic matrix composites.

2.1.1. Particle-reinforced composites

For the particle-reinforced composites, short particulates are
used as reinforcements, and based on the average size of these
reinforcements this composite type can be classified as either large
particle or dispersion-strengthened composites (see Fig. 5). In the
former, the large particles, which are millimeter sizes or more,
are the major load bearers and tend to restrain the matrix defor- Fig. 6. Theoretical models of the modulus of elasticity of composites. Curves 3, 5
mation around their shared surfaces. These restrictions is the main and 4, 6 are the approximate lower and upper bounds, respectively, of the models
developed by different authors Ahmed and Jones (1990).
strengthening mechanism in large particle composites. Dispersion-
strengthening composites, on other hand, make use of nanometer
size particles, and unlike the large-particle composites the matrix predicting the mechanical properties of particulate-filled compos-
bears the major chunk of the load when subjected to a mechanical ites Ahmed and Jones, 1990; Ishai and Cohen, 1967; Paul, 1959;
stress. The strengthening mechanism in this case happens in the Hashin, n.d.. Fig. 6 shows different theoretical models, including
atomic level and it involves the obstruction of the propagation of the lower and upper bound derived from the law of mixtures.
dislocation lines along the matrix by the dispersed particles. Experimental results usually vary with the theoretical models
The range of values of the mechanical properties of a composite due to the limitations of the manufacturing processes.
such as modulus of elasticity can be found by employing a funda-
mental principle known as the rule of mixtures. This rule states
2.1.2. Fiber-reinforced composites
that the mechanical property of a composite material falls between
This is the most widely known, fabricated and used type of
the estimated theoretical lower and the upper bounds of the
composite material system. The sys-tem is put together by sur-
mechanical property in question. This estimate is calculated using
rounding fibrous materials with high mechanical properties such
the individual mechanical properties of the composite’s con-
as strength and modulus of elasticity, with a matrix, such as a
stituent materials and their volume fractions. The assumption that
metal, polymer or ceramic. The resulting strength and stiffness of
the property of a composite is the weighted average of the proper-
a composite depends, not only on the individual properties of the
ties of its constituent parts on a volume basis.
constituent materials, but on a dimensionless quantity known as
E ¼ Em V m þ Ei V i ðUpper boundÞ ð1Þ the length to diameter ratio, of the fibrous phase Fu and Lauke
(1996). Depending on this ratio and the fiber orientations, fiber-
reinforced composites has been classified into three main groups:
Em Ei
E¼ ðLower boundÞ ð2Þ continuous or long and aligned, discontinuous or short and aligned,
Em V i þ Ei V m
and discontinuous and randomly oriented (see Fig. 7).
where E and V denote the modulus of elasticity and volume fraction As mentioned earlier, the fiber length-to-diameter ratio is one
respectively. The sub-scripts m and i represent matrix and inclusion of the critical factor that determines the final strength and stiffness
or particulate phases, respectively. Since the size, shape, and distri- of the resulting composite. The minimum length required for effec-
bution of inclusions as well as their interfacial adhesion with the tive strengthening and stiffening of composites is known as the
surrounding matrix play a huge role in the mechanical properties critical length, and this quantity has been found to be strongly
of a composite, the margins of deviation of the rule of mixtures related to the ultimate tensile strength of the fibrous material rf
are huge Ahmed and Jones (1990). This limitation has led to the and the degree of bonding between the fiber and the matrix sc as
development of different theoretical and experimental models for well as the diameter of the fiber as given in Eq. (3).

Fig. 5. Types of particle reinforced composites (a) Large particle (b) Dispersion – strengthened.

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx 5

Fig. 7. Schematic diagram of fiber reinforced composites (a) continuous and aligned (b) discontinuous and aligned (c) discontinuous and randomly oriented.

Tsai (2018). Two main types of structural composites exist: lami-

nar composites and sandwich panels (see Fig. 9). A laminar com-
posite is made from two dimensional sheets with different
preferred high strength directions stalked and laminated by an
adhesive. The term ‘two dimensional’ is used because the large sur-
face cross-sectional area to thickness ratios of the individual
sheets. These sheets are often continuous and aligned fiber-
reinforced composites. Unlike the laminar composites, sandwich
panels are made of a high strength exterior and a relatively soft
core. A laminating agent is used to hold the two parts together.
The outer sheets are made of materials with high strength and
stiffness such as laminar composites (e.g., plywood), metals (e.g.,
steel and titanium) and fiber-reinforced plastics (Callister and
Rethwisch, 2007). Wood, honeycomb, and thermosets (e.g., epoxy
and phenolic), on the other hand, are the preferred materials for
the core (Callister and Rethwisch, 2007).
A well-designed sandwich panel should be able to withstand
both compressive, tensile and shear stresses without failure. High
temperature resistant adhesives are often employed to prevent
delamination in high temperature applications.

Fig. 8. Schematic diagram of the stress–strain curve of a continuous aligned fiber-

2.2. Properties of composite materials
reinforced composite subjected to a longitudinal load. The stress–strain curves for a
brittle fiber and a ductile matrix is also shown. As previously mentioned, composites with different property
combinations exit due to the unique flexibility in their design
and manufacture. Therefore, unlike traditional materials such as
rf d steel, there are no fixed values for the properties of composites.
lc ¼ ð3Þ
2sc However, one characteristic property that is common with most
composites is low weight-to-strength ratio. This attribute is the
where lc is the critical fiber length and d is the fiber diameter.
reason for their wide applications in biomedical, automobile and
Experimental studies have shown that for continuous fiber type
aerospace industries. In general, composites are designed to have
composites, this critical value is less than the actual fiber lengths
a predetermined specific load-bearing capacity and other perfor-
and that the reverse is the case for discontinuous fiber types (Callis-
mance characteristics superior to other materials. Such properties
ter and Rethwisch, 2007; Fu and Lauke (1996); Petersen (2005);
include:
Takagi and Ichihara (2004).
In terms of the behavior of composites under tensile load, the
- High corrosion resistance
stress–strain relationship is dependent on the direction of the load
- High fatigue resistance
relative to the longitudinal axis of the fiber. This is only the case for
- High impact strength
a continuous and aligned fiber composites. Discontinuous and ran-
- Low weight-to-strength ratio
domly oriented fiber type behaves differently. The stress strain dia-
- Low thermal and electrical conductivity
gram for fiber, matrix and composite is shown in Fig. 8. The failure
- High wear resistance
strength (stiffness) of the fiber material is usually many order of
- Creep resistant
magnitude higher than that if the matrix. However, the matrix
has higher ductility and therefore higher failure strain than the
3. Composite biomaterials and their applications
fiber. Because of these, the failure strength and strain of fiber-
reinforced composites are located between those of their respec-
These are composite materials used in the medical field. Their
tive fibers and matrices.
application in the medical field ranges from handling biologicals
to diagnoses and treatment of different diseases and injuries.
2.1.3. Structural composites When properly designed, composite biomaterials can be used to
Just as the name implies, a structural composite is a system of as direct substitutes or integral functions of organs that had been
composites carefully arranged and held together with a homoge- damaged by traumatic or pathological incidents Salernitano and
nous adhesive material Chawla (2012). The final properties, espe- Migliaresi (2003). The possibility of manufacturing composite bio-
cially the mechanical and structural integrity of a structural materials to have precise predetermined specific physical, chemi-
composite, depends on the properties of the individual composi- cal and mechanical properties for peculiar applications is one of
tions of each of the constituents as well as on the geometrical the major reason they are currently the most widely used in the
designs such as shape and size of the bulker structural elements medical field. Other types of biomaterials, both natural and artifi-

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
6 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx

Fig. 9. Schematic diagrams of the structural composites (a) laminar composite (b) sandwich panel.

cial, have been used for decades but composites have revolution- flow channels such as in the heart, peripheral arteries, veins,
ized the biomedical engineering field. The continued improvement throat, and digestive systems Serruys et al. (2006), a surgical pro-
of these materials and the breakthrough in the invention of other cedure known as angioplasty (Fig. 11(b) and (c)). These materials
sophisticated medical devices have seen an increase in accident are also used temporarily during surgical operations to keep such
and disease survival rates, quality of life and life expectancy channels open. The commonly used materials for stents are stain-
Salernitano and Migliaresi (2003). Like the composites materials less steel and other alloys of iron, titanium and its alloys, magne-
that find applications in other field such as in construction and sium alloys, cobalt alloys, and plastics, however, composite
manufacturing, composite biomaterials are characterized based biomaterials such as metal and polymer matrix composites are
on their constituent parts: particle-reinforced, fiber reinforced beginning to serve as better alternatives Serruys et al. (2006). This
and structural type composite biomate-rial. Again, a typical com- is because of the flexibility composites brings in stent designs as
posite biomaterial usually exhibit performance properties that well as their low cost, biodegradability, and manufacturability.
are different from those of its constituent parts (matrix and inclu- Modern composite stents have the short-term structural integrity
sions). The various constituent parts of composite biomaterials is to support channel vessels and the ability to be fully absorbed by
shown in Fig. 10. the surrounding tissues on the long term Erne et al. (2006). These
materials also have reduced vascular tissue irritation because their
3.1. Cardiovascular applications biocompatibility is achieved through design that is based on the
knowledge of the interaction between the surface of the stent
The cardiovascular system commonly known as the circulatory material and the surrounding biological tissues.
system is one of the main control systems in a human body. This The pacemaker, arguably, is one of the most important heart
physiological system which is composed of the heart, the blood support systems ever to be invented by the biomedical engineers.
vessels, and the blood ensures that nutrients are transported to This lightweight electrochemical system is used to maintain the
various organs located throughout the entire body system. Meta- proper pumping and circulation of the blood in the heart by mon-
bolic wastes are also removed simultaneously as the heart pumps itoring and controlling the heart rhythms. Fig. 12 shows the electri-
and the blood vessels circulates the blood. Surgical treatments are cal system and signal of a normal human heart. The four main parts
often required to take care of congenital or acquired diseases of the of the pacemaker are the connector block, lithium ion battery, lead,
heart such as the coronary artery disease (CAD) and arrhythmias and the case. The case houses pulse generator which houses the
(Fig. 11(d)). Physical injuries to the cardio system also required battery and the connector block and is surgically place above the
the surgical repair or replacement of some parts. The stent and top layers of the skin located below the collarbone (Fig. 12(b)).
the pacemaker are two popular biomaterials used in cardio related The conductive tip of the lead is placed in the appropriate chamber
treatments. Stents are biomaterials used to open up or prevent of the heart and then connected to the connecting block through
disease-induced constrictions such as thrombosis (blood clot) in the subclavian vein. Before now, alloys such as platinum alloy were

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx 7

Fig. 10. Constituents of composite biomaterials.

the main component parts of the pacemaker, nowadays, compos- cavities, on the other hand, are diet related and are currently
ites are beginning to serve as more sustainable alternatives. For prevalent in children. Dental injuries from physical accidents can
instance, composites have replaced the metal case of pacemakers cause permanent physical dental damage or increase the chances
because of their light weight. The former is also more corrosion of teeth infestation. In recent years, the number of accidents and
resistant than the latter, and this has reduced the number of violence have increased in the last century, consequently increas-
reported pacemaker related skin reaction cases. ing the number of head injuries that often times affect the dental
system. Since the enamel and dentine are composed of calcium
3.2. Dental applications phosphates and collagen, composite biomaterials such as polymer
matrix composites are currently used to fill up cavities, to restore
In order to swallow food, the human teeth, which are classified fractured teeth and for dental implants for teeth replacement or
as incisors, canines, premolars and molars, have to cut and crush aesthetic purposes Salernitano and Migliaresi (2003). These mate-
the food into smaller particles. The incisors which are the eight rials are more biocompatible than the traditional dental metallic
middle teeth are responsible for cutting, the canines which are biomaterials such as silver amalgam. Silver-mercury amalgam fill-
the four pointed-shaped teeth adjacent to the incisors are respon- ing have very high toxicity and acrylic resins possess low mechan-
sible for tearing, while the premolars and molars are responsible ical strength and stiffness for use as artificial posterior teeth.
for crushing. The human dental systems is also important in speech Fig. 13(a) shows the natural tooth and an artificial implant. To
or sound making. Like every other part of the human body, the replace a fractured or missing tooth, the flap is raised, exposing
dental system can be defective or damaged due to birth defects, the bone. A hole is made in the bone and a screw is fastened in
diseases or injury. The results of genetic mutations include missing the hole. The abutment, which contains the artificial tooth, is then
dentition and abnormal tooth growth. Plague and caries (cavities), fastened to the screw. Fig. 13(b) and (c) also shows the before and
also known as tooth decay, are the most common diseases of the after the use of composite tooth filling. Detailed procedure for
teeth. The former is an accumulated biofilm that is totally made tooth replacement surgery is beyond the scope of this work but
of bacteria. These bacteria populate and spread by feeding on food can be found in the literature.
particles that are left in and around the teeth, and in the absence of Some dental prostheses are used in vivo (fixed bridges) while
oxygen they produce lactic acid which depletes the phosphorous some are removable. Removable dental prostheses require inter-
and calcium in the enamel, making them susceptible to infections. mittent use due to long-term discomfort to the patient. These
Phosphorus and calcium are important tooth minerals, and contin- materials are usually made of high corrosion resistant glass rein-
uous depletion can lead to complete tooth destruction. Caries or forced polycarbonates. Fixed bridges are manufactured mainly

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
8 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx

Fig. 11. (a) Fully dilated absorbable stent Erne et al. (2006) (b) angioplasty (c) stent placement (d) comparison between the normal heart and the heart with CAD (https://
www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/angioplasty_and_stent_placement_for_the_heart_92, p07981).

Fig. 12. (a) The electrical system of the heart (b) the pacemaker (https://www.hopkinsmedicine.org/healthlibrary/c onditions/cardiovascular_diseases/overview_of_pace-
makers_and_implantable_cardioverter_defibrillators_icds_85, P00234).

from ultra-high molecular weight polyethylene. More recently, a 3.3. Artificial cartilage
methacrylic matrix reinforced with fiber and inorganic particles
has been found to have better mechanical and aesthetic properties Cartilage is a soft and slightly flexible bone structure that can be
than the conventional polymer matrix composites used in dental found in the joints, the nose, the rib cage, and in the ear. Its main
applications. Titanium-hydroxyapatite is another dental material function in an adult is to connect bones together. The majority of
that has received wide attention. Hydroxyapatite is used as the the skeletal tissues of an infant is made of this material, which
lower part of the implant because of its bioactive compatibility are then gradually converted into the more rigid bone tissues as
with the surrounding tissues while titanium which has high they grow. When absent since birth or damaged due to develop-
mechanical strength is used as the upper part Salernitano and mental diseases or physical injury, the cartilage can be replaced
Migliaresi (2003). by polymeric composites such as poly [2-hydroxyethyl methacry-

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx 9

Fig. 13. (a) Natural tooth and dental implant (https://www.efp.org/patients/dental-implants.html) (b) before tooth filling (c) after tooth filling (http://www.sksmileden-
tal.com/services-provided/tooth-coloured-fillings-composite/).

late] (PHEMA) reinforced with polyethylene terephthalate (PET) gue resistant composite has since been used as ligament prosthe-
synthetic fibers. By varying the volume fractions of either con- sis. PET reinforced PHEMA, which is used as cartilage prosthesis,
stituents of this biomaterial, properties similar to the natural car- is also used in this application as well although experimental study
tilage can be obtained Salernitano and Migliaresi (2003). Another has shown that they instigate synovitis Salernitano and Migliaresi
composite biomaterial used in the replacement of cartilage is the (2003). To overcome this problem, a terephthalate polyester fiber
HA coated ultra-high molecular weight polyethylene. This material and collagen matrix based composite with high fracture strength
is widely used in the replacement of articular cartilage, interverte- has been developed Huguet et al. (1997). This material showed
bral fibrocartilage and menisci due to their long-term performance no abnormal reaction with the surrounding tissues when tested
Shikinami and Kawarada (1998). Failures in the use of artificial car- in vivo for about six months, although less success was obtained
tilage are mainly due to wear and fatigue due to cyclic loading. in terms of the growth and penetration of fibrous tissues between
Improvements are constantly been made to address these issues. the prosthesis and the surrounding bones Huguet et al. (1997).
For instance, injectable hydrogels, which are polymeric biomate-
rial, are sometimes incorporated with composite biomaterials to
reduce wear and to accelerate healing. 3.5. Joint prostheses

A joint is simply a region in the human body where two or more

3.4. Artificial ligament bones meet. These joints bears weight, and also allow voluntary
activities such as movements. There are over 300 joints in a typical
Ligaments are fibrous tissues that connect or hold bones and human body, the majority of which are constantly used to carry
cartilages together. Anterior Cruciate Ligament (ACL) injuries are out some activities. As a result, the joints are susceptible to phys-
one of the common, especially among athletes. Polymeric and com- ical injuries such as dislocation and fracture or diseases such as
posite biomaterials are used for the repair or for the complete inflammation, also known as arthritis. Sometimes, a joint can be
replacement of this tissue in order to restore the proper function- restored to its healthy condition with medications and processes
ing of the diseases infested or injured joints. Just as in the case of and encourage its healing, other times, a complete joint replace-
artificial cartilage, failure in the artificial ligament is primarily ment is required, especially in severe cases of arthritis or physical
due to wear and cyclic loading. Long term failures are due to the damage. Fig. 14 shows the schematic diagrams of a badly diseases
weak abrasive resistance of the inclusions, low flexural and tor- infested knee joint and an artificial replacement (OrthoInfo., 2019).
sional strengths and the inflammation of the synovial membrane The prosthetic femur and tibia components are attached to the
Salernitano and Migliaresi (2003). A biodegradable composite bio- femur and tibia, respectively, by drilling through them, and insert-
material that is made from polylactic acid and hyaluronic acid ing the stems and exposing the heads. These parts are put together
ester is used as a prosthetic ligament. The low wear rate of this to have the same degree of freedom as a natural knee.
prosthesis allows the natural healing of damaged ligament tissue. The hip joint works almost the same way as the knee joint.
Kazanci et al. (2002) studied the fatigue behavior of UHMWPE When damaged, the hip joint can be completely replaced with arti-
reinforced ethylene-butene copolymers under cyclic loading and ficial parts. These biomedical devices are usually made of a combi-
found that copolymer type/angle combination can yield very high nations of metals, polymers, ceramics and composites. The
fatigue resistant composites for biomedical applications. This fati- schematic diagrams of a natural functioning hip joint and an arti-

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
10 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx

Fig. 14. Schematic diagram of (a) damaged knee joint (b) knee joint completely replaced with biomaterials (https:// www.orthoinfo.org/en/treatment/knee-replacement-
implants/).

Fig. 15. The schematic diagram of the hip joint (a) normal hip joint (b) artificial hip joint showing the stem and cup embedded in the femur and the pelvis, respectively Tuan
et al. (2016).

Fig. 16. 16: (a) X-ray image of damaged hip joint recuperating under screws and plate (http://www.rapidmade.com/rapidmade-blog/2015/1/9/if-the-3d-screw-fits-wear-it),
(b) comparison of the bending properties of materials used in bone plates (http://uon.technologypublisher.com/technology/17632).

ficial hip joint are shown in Fig. 15. The stem that is attached to the When a patient is suffering from a minor hip injury, bone plates,
ball is embedded in the femur while the acetabular cup/shell is screws and wires are used to facilitate the healing process. These
implanted to the pelvis with the help of a fixation agent. The stem parts are usually made of metallic biomaterial and/or composite
is usually made of alloyed metals or metallic composites because biomaterial. Fig. 16(a) shows the x-ray image of a hip joint stitched
of their high strength, both tensile and compression. The ball is together with the help of screws and a bone plate. Bone plates,
now being manufactured from composite metals because of their when implanted, are subjected to high tensile, compressive and
high wear resistance compared to ceramic biomaterials. bending stresses and as a result materials which can withstand

Please cite this article as: M. K. Egbo, A fundamental review on composite materials and some of their applications in biomedical engineering, Journal of
King Saud University – Engineering Sciences, https://doi.org/10.1016/j.jksues.2020.07.007
 M.K. Egbo / Journal of King Saud University – Engineering Sciences xxx (xxxx) xxx 11

4. Conclusion

The unique thing about composite materials in general is the

fact that they can be tailored to suit specific applications. The
biomedical industry has taken advantage of this multi-
component material in the design and manufacture of biomaterials
that can be used for the repair or the complete replacement of dif-
ferent human tissues or organs. Composite biomaterials have
numerous advantages over the traditional metallic and polymeric
biomaterials in terms of their physical, mechanical and chemical
properties. With advances in innovative technology, new compos-
Fig. 17. The use of bone cement as fillings for fractured skull (https://honestver- ite materials such as the advanced composites are currently being
sion.com/bone-cement-market-20 19-2025-global-share-outlook-forecast/). looked into, and this has the potential to revolutionize the world of
biomaterial science and engineering.
such stresses are used in their fabrication. A comparison of the
bending properties of composites, polymers and metals used as
Declaration of Competing Interest
bone plates is shown in Fig. 16(b).

The authors declare that they have no known competing finan-

3.6. Bone repair cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
Composites have been shown to be useful in repairing bone
fractures. This is again due to the fact that their composition mim- Acknowledgments
ics the structure and properties of bones. This makes them highly
compatible osteoconductive materials that can provide support The author would like to thank Professor Asmatulu of the
for healing bones until they regain their strength. In addition to department of Mechanical Engineering at Wichita State University
acting as a frame, the composites are biodegradable, meaning they for inspiring this work. The author also extends his gratitude to Dr.
are not required to be removed after serving their purpose. Com- Christian Edeani and Mrs Christiana Edeani for their unending love
posite materials can also be used to make internal fixation devices. and support. Finally, the author would like to thank Chioma Obi for
In the past, they have been made from metals. While metal devices her unequivocal unconditional love, support and motivation.
boast high levels of strength and durability, they come with the
problem of corrosion and stiffness higher than that of bone which
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